INDICATIONS AND CONTRAINDICATIONS OF DENTAL IMPLANTS
Course outline
Introduction
- Implant indications
- Implant contraindications
- Absolute contraindications
- General contraindications relating to
- Relative local contraindications Conclusion
Bibliographic references
EDUCATIONAL OBJECTIVE OF THE COURSE
Clearly identify the indications for successful treatment
Introduction
Implantology, the legacy of Professor Brånemark and the concept of osseointegration, has developed since the early 1980s to become a common therapy today. This discipline offers a response to partial or total edentulism, single or multiple, unilateral or bilateral, for fixed or removable restorations.
However, this discipline obeys rules and conditions which determine these indications and contraindications.
- Implant indications
Dental implants have various indications:
In fixed prosthesis:
- Single edentulism with healthy adjacent teeth
- Request for conservative therapy
- Free posterior edentulism making fixed restoration impossible
- Absence of dental abutment to make a fixed prosthesis
In removable prosthesis:
- Psychological refusal to wear an auxiliary prosthesis
- Parafunctional habits that compromise the stability of an adjunct prosthesis
- Lack of retention of an adjunct prosthesis
- Instability of an adjunct prosthesis
- Functional discomfort with removable prostheses
In ODF:
- Dental agenesis
- Provision of orthodontic anchoring to achieve movements at the level of the same arch, inter-arch movements, movements of the bone bases.
- Implant contraindications
Relative or absolute contraindications (CI) for implant surgery are related to conditions for which the surgical procedure is risky or interferes with tissue healing.
- Absolute contraindications
- Heart diseases at risk and at high risk of infective endocarditis : aortic or mitral valve prostheses, cyanotic congenital heart diseases and history of infective endocarditis; heart diseases at risk are aortic or mitral valve diseases, obstructive cardiomyopathies.
- Recent heart attack .
- Severe heart failure .
- Congenital and acquired immunodeficiencies (AIDS)
- Patients treated with immunosuppressants or long-term corticosteroids.
- Conditions requiring or expected to require organ transplantation .
- Cancers in development .
- Bone metabolism disorder : osteomalacia, Paget’s disease, osteogenesis imperfecta.
- Age: advanced age is not a contraindication to dental implants, but it is important to ensure the patient’s general condition, manual dexterity, and mental aptitude to receive implants. On the other hand, in children or adolescents, various studies show that the implant behaves like an ankylosed tooth and does not follow the vertical growth of the jaws. It is therefore imperative to wait until the end of jaw growth before considering implant therapy in adolescents.
- General contraindications relating to
- Diabetes: it increases the risk of impaired healing and postoperative infection
- (Roberts, Simmons; Garetto, De Castro 1992) (55). In poorly controlled insulin-dependent diabetics (type 1), healing is more frequently impaired and infectious complications are increased. However, if the patient is properly controlled and antibiotic prophylaxis is performed, there is no particular operative risk.
- Pregnancy.
- Coronary insufficiency, angina .
- Anticoagulant treatments : These patients should be treated with the usual precautions. Before any intervention, it is recommended to consult the therapist concerned in order to continue, stop or modify the treatment.
- Autoimmune diseases: Lupus, Rheumatoid arthritis, Scleroderma, etc. Long-term corticosteroids have been associated with impaired healing and an increased risk of postoperative infection. They can also disrupt bone metabolism. Asepsis must be rigorous and antibiotic prophylaxis will be necessary.
- Seropositivity: If implant placement represents a formal IC for patients with a declared AIDS stage, for patients with signs of immunodepression, in particular those whose LT4 are lowered, implant placement should be discussed and the benefit/risk ratio must be measured.
- Heavy smoking: Smoking is considered a factor in implant failure. Heavy smokers are at increased risk of impaired healing and bone metabolism.
- Psychiatric diseases, psychological disorders : Some psychiatric conditions may represent a CI for implant surgery. These include psychotic syndromes such as paranoia or schizophrenia, personality disorders and neurological disorders, presenile dementia. It is also very important to detect patients with unrealistic aesthetic demands. The higher the aesthetic demand, the more cooperative the patient must be and fully aware of the difficulty, constraints and duration of the treatment.
- Drug addicts, alcoholism : Treatments that require rigorous long-term maintenance should be avoided. These drugs also impair the healing process.
- Cervical-facial irradiation: The main danger is osteoradionecrosis. Irradiation causes early side effects on tissues and late effects on bone metabolism. Bone vascularization is impaired even after a single low-dose radiotherapy. Susceptibility to infection is increased. Healing is impaired especially in the mandibular bone due to its composite structure and reduced vascularization. Implantation should be
be carried out with a rigorous aseptic protocol, preferably under general anesthesia (to avoid the use of vasoconstrictors) and in close collaboration with the team that performed the radiotherapy.
- Relative local contraindications
- Oral dermatoses : candidiasis, eczema, lichen planus, leukoplakia, erosions must be treated before implant placement.
- Periodontal diseases : Periodontal pathogens present in natural teeth can colonize the peri-implant sulcus. The risk of developing peri-implant infections is higher in patients with periodontitis, particularly aggressive forms. It will therefore be necessary to clean up the periodontium and stabilize the disease before considering implant treatment.
- Bruxism: A patient with bruxomania or who has lost their natural teeth through fracture should be considered at significant risk. The intensity of the forces developed during chewing as well as parafunctional habits can have significant repercussions on the stability of implant components. This risk is amplified if the occlusal forces are not distributed along the axis of the implant. Initial occlusodontic therapy should then be indicated.
- Limiting bone volumes and proximity of anatomical structures: In the maxilla, in the presence of significant resorption, the proximity of the nasal fossae and sinuses may limit or even contraindicate the placement of implants. In the mandible, the anatomical structures to avoid are the mental foramen and the mandibular canal. All these structures must be left at a distance of 2 mm from the drilling.
- The lack of bone volume for the implant and its safety distances can be a limitation to implantology, at least as a first-line treatment.
- Unfavorable occlusion: The absence of posterior wedging or incisal guide must be corrected before considering implant therapy in order to harmoniously distribute the occlusal contacts. It is also necessary to have a sufficient intermaxillary distance or a sufficient distance between the crest and the antagonist arch to create a prosthetic space.
adequate (6 mm seems a minimum). Finally, a limited oral opening may contraindicate the placement of implants in the posterior sectors.
- Presence of surrounding bone lesions: periodontal and endodontic lesions of adjacent teeth, presence of granulomas and periapical cysts, sinus pathologies, impacted teeth.
- Poor or neglected oral hygiene .
Conclusion
The fitting of an implant follows precise instructions, which are the result of experiments and in-depth studies in the field.
The surgical procedure is routine and almost painless, however, as with any oral surgery procedure, prevention of intraoperative complications begins with a meticulous interview to assess whether the patient is “at risk”.
The risk may be medical, infectious, hemorrhagic, functional, biomechanical or aesthetic. The contraindications for implant surgery are the same as for any oral surgery that is not urgent.
Bibliographic references
.
- Brägger U, Heitz-Mayfield L. ITI Treatment Guide: Biological and mechanical complications in dental implantology . Paris: Quintessence International; 2018. Chapter 7, Prevention of biological complications; pp. 93-95. 89.
- Davarpanah M, Martinez H. Manual of clinical implantology, cdp Paris 2012.
- Davarpanah M, Szmukler-Moncler S, Rajzbaum P, Sater S, Zyman P, Jakubowicz-Kohen B. Textbook of clinical implantology. 4th ed. France: cdp – JPIO; 2018
- Wismeijer D, Casentini P, Galluci G, Chiapasco M. ITI Treatment Guide: loading protocol in dental implantology in edentulous patients. Paris: Quintessence International; 2018. Chapter 8, Proceedings of the 4th ITI Consensus Conference; pp. 221–227.
INDICATIONS AND CONTRAINDICATIONS OF DENTAL IMPLANTS
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